Which antibiotic is most associated with increasing risk of Clostridioides difficile infection, and what stewardship practice helps reduce this risk?

• A. Clindamycin; stewardship to use narrow-spectrum agents and avoid unnecessary antibiotics
• B. Fluoroquinolones; stewardship to de-escalate therapy promptly
• C. Amoxicillin; stewardship to limit duration
• D. Metronidazole; stewardship to avoid unnecessary combinations

Answer: (A)

Antibiotic exposure disrupts the normal gut microbiota, and when this balance is upset, Clostridioides difficile can overgrow and produce toxins that cause infection. Clindamycin is particularly associated with a high risk of C. difficile infection because it strongly disrupts anaerobic gut flora and can have a lasting impact on the microbial community.

The stewardship practice that best reduces this risk is using narrow-spectrum antibiotics whenever possible and avoiding unnecessary antibiotic use. By targeting coverage to the specific pathogen and minimizing broad-spectrum exposure, you preserve protective gut bacteria and lessen the chance for C. difficile to take hold. De-escalation and limiting duration are helpful strategies too, but reducing overall unnecessary antibiotic exposure and choosing targeted therapy has the most direct impact on lowering C. difficile risk.